All HIV is, is a virus

Michael and I spent Saturday at a life skills class for children enrolled in Nyumbani’s Lea Toto program in Kibera. Children of all ages come once a month to learn about HIV and receive support.

Usually, it’s conducted by Lea Toto staff like Daniel (pictured below) but today Susan Gold, a Fulbright scholar from the U.S., assisted in teaching the class.

Susan (pictured below) created a sexual education program for HIV positive children for her Fulbright scholarship and we were lucky to see her in action on Saturday.


Susan told the 15 HIV positive adolescents that all HIV is, is a virus. Having the virus doesn’t make you a bad person and anyone can get the virus. It has nothing to do with being a good or a bad person. It just means that when you have the virus, you have to take care of yourself and take medicine. She went on to explain that just because you have HIV does not mean you have AIDS.


A child asked Susan what she should say to her peers when they tease her and say mean things to her for her HIV status. Susan told the child that people say things because they’re afraid and people are afraid because they don’t know. People talk about HIV and AIDS in a bad way because they don’t know about it, Susan said. She told the child that when her peers tell her she has AIDS, she can correct them and say no I don’t and I won’t get AIDS because I take my medicine.


“So the more you can teach people about what you have then the less afraid they are because there is nothing scary about people who are HIV positive,” Susan said.



As I was sitting there listening to Susan teach, it occurred to me that I’ve been talking about HIV and AIDS in my blog for over a month now. But I’ve never actually given a definition of what HIV is. And Susan’s right, HIV is simply a virus. But because of stigmas surrounding the virus, it’s treated like a personal defect. And the fear surrounding HIV stems from people’s ignorance about the virus.



By definition, HIV is a virus that attacks certain cells of the immune system called the “helper T-cells” or CD4 cells, which are responsible for helping the body to fight off infections. HIV invades CD4 cells, reproducing within the infected cells, and then bursting into the bloodstream. The immune system responds by producing antibodies to fight the virus and making more CD4 cells to replenish those killed. But this immune response is ultimately ineffective. In the late stages of infection, HIV destroys increasing numbers of CD4 cells until the body’s capacity to fight other viruses and bacteria gradually begins to decline. Eventually, the immune system stops functioning, leaving the body defenseless against other infectious agents.

And by definition, Acquired Immunodeficiency Syndrome (AIDS) is the medical designation for a set of symptoms, opportunistic infections, and laboratory markers indicating that a person is in an advanced stage of HIV infections, with an impaired immune system. Although some people may develops AIDS much sooner, it takes an average of 10 years from the time one is infected with HIV to develop clinical AIDS. As immune functions begin to decline, the body becomes prone to certain opportunistic infections, which vary in different regions of the world, depending upon the locally predominant infectious agents. Thus, it is not AIDS that actually kills a person. It is the opportunistic infections, such as tuberculosis (TB), that kills a person because their immune system is too weak to fight the infection off.



So HIV and AIDS are not the same thing. While HIV is the virus that causes AIDS, a person can live there entire life with HIV and never have AIDS due to antiretroviral drugs. So there is nothing scary about people who are HIV positive. I can kiss, hug, sit on the same toilet seat, drink out of the same cup, eat off of the same plate, and get coughed on by a HIV positive person and not get HIV.



Susan explained to the children the different modes of HIV transmission.
- Mother to Child Transmission (through the birthing process and through breast feeding)
- Sexual intercourse
- Sharing of sharp objects
- Blood transfusion



She also explained the importance of taking antiretroviral drugs and not missing a dose. She told the children that the medicine was their gun against the virus. The antiretroviral drugs (ARVs) allow for children to live long healthy lives, get married, have children and possibly not pass the virus on to their child. Currently in Kenya, 35% of HIV positive mothers pass the virus on to their child. But if a mother has been taking ARVs for a significant period of time, the chances of passing on the virus are small.



I wish more people could take the time to learn about HIV and AIDS and spend time with HIV positive people and realize there’s nothing scary about it. Throughout history, ignorance has stemmed most kinds of discrimination and stigmas. People are scared of the unknown. They make assumptions about what they don’t know and create walls. But if people tore through their ignorance, we would have a more accepting world to live in.

The Most Powerful Person in the World

Bill Gates? George Bush? Donald Trump? The Pope?

Nope, an adolescent girl.

Here’s some information I received from the Coalition for Adolescent Girls, which was founded by the United Nations Foundation and The Nike Foundation.

An adolescent girl can be the most powerful person in the world. She’s the key to ending generations of poverty. As a young woman and mother, she will make the decisions that determine the health and education of her family. She will shape the economic potential of her family, community and nation.

There are now more than 500 million adolescent girls in the developing world.



Today, adolescent girls are at a crossroads. From here they can prosper by continuing their schooling, remaining free of HIV, increasing their family’s income, deciding when to marry and raising healthy, educated children. Or they can live in poverty by being forced to abandon their education, be exposed to unsafe sex and HIV, marry early to an older man, be unable to feed their families and not afford to school their children.



A large resource gap exists in the development landscape for adolescent girls. Currently, in many cases 80-90 percent of youth program participants are boys due to the daily challenges girls face. Girl-specific resources will make the difference. They will give her one more year of school. An extra year before she’s married. A year to learn a trade.



These opportunities not only improve an adolescent girl’s life, they put everyone—her brothers, her sisters, her children and grandchildren—on a path towards progress. They create healthy, educated and economically stable communities and nations.



A more prosperous future lies in the hands of one of the most powerful people in the world—an adolescent girl.

When girls are educated, healthy and financially literate, they will play a key role in ending generations of poverty.

Not too long ago I was an adolescent girl. And to think that at age 15 I was powerful seems ridiculous to me, but the more I think about it, I was powerful. I just didn’t realize it. I was powerful. I attended an all girls’ college preparatory school. I was smart. I was healthy. I knew I would go to college. I knew I would get a job. I knew when and how to say no to a man. And most of all, I wanted a future.

I look at adolescent girls here who have dropped out of school, who depend on men for financial security and who already are pregnant.

But I also look at adolescent girls here who tell me their dreams for the future—going to university, getting a job, getting married to a man who treats them well and loves them, and not passing on HIV to their children.

Rosealia is one of these adolescent girls who gives me hope.

Rosealia (pictured above) was born with a twin brother, Titus, to an HIV positive mother. Titus came first, Rosealia followed. After Titus was born, a lot of blood was left over, which infected Rosealia with HIV because it’s not sitting in the womb that causes the fetus to be infected with HIV. It’s the process of coming out of the mother’s vagina when the fetus can swallow or inhale some of the mother’s blood that causes the virus to be transmitted.

Today, Rosealia is positive but her brother, Titus, is HIV negative. Rosealia has been taking antiretroviral drugs for two years. Rosealia’s father died several years ago leaving her mother behind to care for her, Titus and her other siblings in Africa’s second largest slum, Kibera.


I noticed Rosealia before I even knew who she was. Michael and I were attending an adolescent training program for children enrolled in Nyumbani’s Lea Toto program in Kibera. The thirteen year-old kept raising her hand and confidently answering the questions correctly.

Her twin brother Titus is number one in their class. Rosealia is number two. Rosealia loves to read- especially Harry Potter, and she writes in her journal every night in English to improve her skills. Her hope is that one day she will become a dean of a university.


And then there’s Elizabeth, who lives at Nyumbani’s Children Home.

Elizabeth is 17 years old but looks like she’s no more than 10. Earlier this year, Elizabeth came very close to death. Her lifelong battle with HIV has permanently stunted her growth and put her behind in school.

She’s currently in sixth grade. She has a 15-year-old sister Joyce (pictured below in the middle) who is also HIV positive and lives at Nyumbani. But you would never guess that Elizabeth is older than Joyce.


But Elizabeth is one of the brightest young women I’ve met here. She dreams of going to university, becoming a manager of a large office, marrying for love and having several children.


You see, adolescent girls really do hold all the power. If they feel empowered enough to stay in school, practice safe sex, marry for love, earn their own income and learn how to raise their children so that they won’t become infected with HIV, then change would begin. A more prosperous future would not only unravel for that one adolescent girl but for her family, her friends who watch her lead by example and her own children.

Back in the USA- well not really but kind of

Today we visited the U.S. embassy. The embassy called a town hall meeting for all U.S. citizens living in Kenya to discuss foreign policy, terrorism and security concerns. After the 1998 bombing of the former U.S. embassy in the city centre of Nairobi, the embassy was moved to the outskirts of the city. The embassy sits on a huge compound back far from the road. I’m assuming this is to prevent another roadside bombing because that is how the former bombing occurred. While we have been around a few Americans since being here, it was a special treat to be around so many- even though they were complete strangers. And technically when you’re at the embassy, you’re on U.S. soil. Security is really tight here understandably so we had to wait in several lines to get through security checkpoints.

And even though I was technically on U.S. soil, I couldn't help feel a bit nervous because it was just earlier this year that two women were killed while leaving the embassy. They were the wife and the mother-in-law of one of the staff members. They were driving in an embassy vehicle on the highway back towards Nairobi. Their vehicle was carjacked. When the two women hesitated after being ordered to get out of the car, both were shot dead.

Once inside the embassy grounds, the meeting started. We were first greeted by the U.S. ambassador, Michael Ranneberger, and then later heard from a few security directors. As I’ve mentioned before, Kenya will be having a presidential election in December (actually the election date was just announced today for December 27th). Security concerns arise around election time here because there is almost always political violence. But Ambassador Ranneberger did reassure us that no matter if Kenya's current president, Mwai Kibaki, gets reelected or candidates Raila Odinga or Kalonza Musyoka get elected, American foreign policy towards Kenya should remain the same. And that Kibaki, Odinga, and Musyoka are all friends of the U.S. Some U.S. citizens raised concerns over the continued problem of Kenyan police demanding bribes at routine checkpoints. The ambassador reported that unfortunately there was little the embassy could do about that and it was unlikely it would be eliminated soon.

Here’s a few numbers about funding I learned while at the embassy:
* $500 million will be given to Kenya in 2008 through the President’s Emergency Plan for AIDS Relief (PEPFAR) making Kenya the second largest PEPFAR recipient.
* $20 million will be given to Kenya in 2008 through the President’s Malaria Initiative.
* Despite the U.S. travel warning still in place for Kenya, American tourism to Kenya is booming. By the end of 2007, 100,000 American will have visited Kenya. Only the U.K. sends more of its citizens to Kenya than the U.S.
* And $1.5 billion comes from the U.S. (through official government donations, non-profits, private donors, etc.), which accounts for 16% of Kenya’s gross domestic product.

No matter what your political beliefs are- Republican or Democrat- the numbers don’t lie. The U.S. is making a difference in Kenya, particularly PEPFAR. It’s one thing to be in the states and read in a newspaper that PEPFAR is sending $500 million to Kenya to pay for antiretroviral drugs for HIV positive children. And it’s a totally different thing to see with your own two eyes the children that are benefiting from these drugs, that without PEPFAR’s funds wouldn’t be having another Christmas or living into their adolescent years or possibly even having a tomorrow. Seeing the beneficiaries of this money makes me proud to be an American.

Hope in Kibera

I must admit that when we headed out for Kibera Thursday morning, I was a bit reluctant. Tuesday was so draining and depressing and I didn’t know if I was up for it again. We met an American woman named Andrea (pictured sitting next to me) who I was put into contact with through an organization based in Franklin, Tenn. called African Leadership. Andrea started coming to Kibera several years ago to volunteer and do mission work. It was through her work at Kibera that she met her husband who is a Kenyan man. Now Andrea is expecting her first child and works in Kibera a few days a week.



We met Andrea for a quick cup of coffee at a coffee shop called Dormans in the YaYa Center near our apartment. From there, we took a matatu into Kibera. Our first stop was a preschool named Jamii. You would have thought Michael and I were Queen Elizabeth and Prince Charles. The children totally freaked out, screaming, running to us trying to grab our hand. One little girl named Anna wouldn’t let go of my hand the entire time we were inside.



Our second stop was Little Rock preschool. This preschool was started by two Kenyan women, Christine (pictured below) and Lilly.

Most preschools in Kibera charge between 500-1000 shillings per month per child, which is the equivalent of U.S. $8-$16. That may not seem a lot to many of you, but trust me to the 1 million people struggling to survive in Kibera, it’s everything. When you have to come up with money to pay to use the toilet every time you need to do your business, when you need to come up with money to get a jug of water or buy some food or pay rent, there might not be 500 shillings to spare to send your toddler to preschool.



Lilly and Christine saw the enormous need for affordable preschool education in Kibera. So in 2003, they opened Little Rock Preschool only charging each child 100 shillings per month, which is about U.S. $1.50.

Four years later, Little Rock has 150 children enrolled in their preschool and it’s still growing. In a country where there is no Disability Act, children with disabilities often get shunned. Their parents don’t know how to care for them, the schools won’t accept them, and they get left behind. But Little Rock opens its doors to children with down syndrome and cerebral palsy. Deaf children also face similar obstacles in poverty stricken areas because their parents don’t know sign language. Several years ago, Little Rock opened a special deaf unit where three trained teachers (one pictured below) lead the program.



On Thursday, the children at Little Rock Preschool were practicing their Christmas performance and graduation ceremony, which will be performed on November 30th. They sang Christmas carols, acted out a play, and practiced getting their diplomas. I was smiling from ear to ear.


After the practice, Christine took us to the Little Rock Library. She explained that when children graduate from Little Rock and move on to primary school, some children can’t afford to buy their own books. While primary school is free in Kenya, children have to purchase uniforms and books- an expense that some families just can’t afford.

So Little Rock purchased several textbooks plus additional story books for Little Rock alumni to use in the library after school in order to do their homework. They’ve also organized a Football League (American soccer) for the boys to play in three days a week.


While what I saw on Thursday doesn’t erase what I saw on Tuesday, it does give me hope. It gives me hope to see the smiles on the children’s faces, the children’s eagerness to learn and most importantly it gives me hope to find good people like Christine and Lilly who haven’t given up on these children, who still believe that children in Kibera deserve an education, and that they can have a bright future ahead of them. At least, that’s my hope.

Kibera

I've been sitting here in front of the computer screen for 30 minutes now trying to figure out how to explain what I saw yesterday. It's not just a case of writer's block. it's more than that. It's disbelief, it's shock, and it's a feeling of complete helplessness. The one question that keeps repeating itself in my head is How is this possible? How can people truly live like this and the government not do anything to help?


Trash is everywhere- pounded into the dirt, lying next to vegetable and fruit stands, piling up near the railroad tracks, burning into the air leaving an odor you can never forget. Mud and dirt line the streets. Flies swarm everywhere you turn. And the smell of flying toilets and trash truly tests your gag reflexes.

I've been on mission trips before to poor parts of the U.S. and poor parts of other countries. But I've never seen something like this. It looks like it should be scenes leftover from a natural disaster.

The only difference is there is no clean up teams in place. This is how it is all the time, 24 hours a day, 7 days a week, 365 days a year.



Michael and I took a matatu to Kibera today. We got off a few blocks early and had to walk to Nyumbani's clinic. As a white American (especially a white American female) Kibera is not a place you want to be walking alone during the day or night. I tried to keep my cool as hundreds of eyes glued to Michael and I as we were trying to find our way. To say I was nervous would be an understatement.



We arrived at Nyumbani's clinic in Kibera around 10 AM and we set out to follow a social worker, Sister Joyce, around to several home visits. Our first stop was to visit a 14 year-old girl who tested positive for HIV when she was born and now at age 14, it has escalated into full blown AIDS. Sara enrolled in the Nyumbani Lea Toto program just a few months ago. She started taking antiretroviral drugs two months ago- the same time she had to stop going to school because she was too weak. Just two weeks ago, she was admitted into a nearby hospital because she had TB and pneumonia. While in the hospital, her spirits dropped and she became very depressed. Once she regained enough strength, she came back home where she is cared for by her 16 year-old aunt pictured below. Sara's parents and siblings have all died from AIDS.


When we walked into Sara's house, I couldn't believe my eyes. Sara weighed 50 pounds. Her legs were smaller than the width of my wrist. She was completely skin and bones.

I've been in hospitals and nursing homes before but I've never seen someone look as sick as this child did. While she's taking ARVs, the likelihood that they will raise her CD4 count enough so she won't have full blown AIDS and instead just have HIV is not very high. It's just not fair. She was born with this horrible disease, the rest of her family has died from horrible disease, and now a teenager just two years older than her is responsible for her care. Sara told us how her favorite subject in school was science and that she wanted to become a doctor and she couldn't wait to get better and go back to school. Sadly, Sara may never get to go back.

What we've been learning is that the subordination of women in Kenya fuels the HIV epidemic. Take Kathy's story for example. Kathy is a 20 year-old HIV positive woman that we visited yesterday.

Kathy is from a city called Kismu. She is the oldest of her four siblings- all of which are boys. Both of her parents died from natural causes when Kathy was 16 leaving her in charge of her 4 brothers. Kathy decided that she should marry so she could provide some economic stability for herself and her brothers. Kathy married a man who did not disclose to her that he was HIV positive. She did not learn that her husband was HIV positive until she learned of her own positive status when she was giving birth to her first child. Her husband moved the family to Nairobi so he could find work but was unsuccessful. Now Kathy lives in a one bedroom shack in Kibera with her 4 brothers, her HIV positive husband and her 2 HIV positive children. Kathy is the only family member who makes any kind of income. Her husband got frustrated at the difficulty of finding work and the realities of Kibera and has turned to drinking. This is a problem all too common. People move from the rural areas to find work in the urban areas only to find out that unemployment is high and Kibera is worse than where they came from.


Unfortunately women often suffer the most from HIV/AIDS. Women have no voice in the bedroom here in Kenya. They don't have a choice of whether or not they want to have sex or whether they want to use a condom. Women have to depend economically on men. Women still do not have equal rights to men. And women are the ones who usually care for those family members who become hill from HIV/AIDS.

I'm realizing more and more how complex HIV/AIDS is. Until some of the many structural inequalities- subordination of women and the huge percentage of poverty- surrounding HIV/AIDS in the developing world begin to change, HIV/AIDS will never be combated.


After completing the home visits, we spent some time in Nyumbani's daycare that specializes in nutritional rehabilitation for HIV positive children. Michael and I were there around lunch time and got to feed several infants. The children are admitted here until they regain their strength and can stay at home with their parents.





I asked Sister Joyce if there was ever a way out of Kibera. She said sadly for most people there isn't a way. It's difficult to find jobs. Men will walk two hours to the Industrial Area in Nairobi to find a day labor job that won't pay more than 100-200 shillings a day which is about $3 per day. Women can find odd jobs like cutting firewood, washing clothes, or walking 10-15 minutes to get water for others. These jobs only pay about 100 shillings which is about $1.50 per day. A typical one bedroom house in Kibera costs 500 shillings a month. To fill up a jug of water costs 5 shillings; however the water is still unsafe to drink so you have to boil the water first before drinking. And to use a toilet costs 3-5 shillings per use. And on top of all that, the government only provides a few free primary education schools, which are already too full leaving parents no choice but to send their children to private more expensive schools if they want their child to be educated.


As Michael and I walked out of Kibera to catch a matatu to go back towards our apartment, we were both speechless. We were both completely drained because seeing everything we saw is exhausting. In a way I miss my ignorance. I'll never be able to forget the mass poverty I saw, Sara's face, and the all encompassing smell of Kibera.